Direct estimation of central aortic pressure from measured or quantified mean and diastolic brachial blood pressure: agreement with invasive records.

Background: Recently it has been proposed a new approach to estimate aortic systolic blood pressure (aoSBP) without the need for specific devices, operator-dependent techniques and/or complex wave propagation models/algorithms. The approach proposes aoSBP can be quantified from brachial diastolic and mean blood pressure (bDBP, bMBP) as: aoSBP = bMBP2/bDBP. It remains to be assessed to what extent the method and/or equation used to obtain the bMBP levels considered in aoSBP calculation may affect the estimated aoSBP, and consequently the agreement with aoSBP invasively recorded. Methods: Brachial and aortic pressure were simultaneously obtained invasively (catheterization) and non-invasively (brachial oscillometry) in 89 subjects. aoSBP was quantified in seven different ways, using measured (oscillometry-derived) and calculated (six equations) mean blood pressure (MBP) levels. The agreement between invasive and estimated aoSBP was analyzed (Concordance correlation coefficient; Bland-Altman Test). Conclusions: The ability of the equation "aoSBP = MBP2/DBP" to (accurately) estimate (error <5 mmHg) invasive aoSBP depends on the method and equation considered to determine bMBP, and on the aoSBP levels (proportional error). Oscillometric bMBP and/or approaches that consider adjustments for heart rate or a form factor ∼40% (instead of the usual 33%) would be the best way to obtain the bMBP levels to be used to calculate aoSBP.

Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods.

Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.

Prevalencia de cardiopatías congénitas diagnosticadas o tratadas por cateterismo cardíaco en pediatría / Prevalence of congenital heart disease diagnosed or treated by cardiac catheterism in pediatrics

Resumen Objetivo: Determinar las cardiopatías congénitas más diagnosticadas a través de cateterismo cardíaco en una población pediátrica de la costa norte colombiana durante el período de 2007 a 2016. Materiales y métodos: Estudio descriptivo, retrospectivo y multicéntrico, cuya población corresponde al total de pacientes de 0 a 18 años en quienes se realizó cateterismo cardíaco diagnóstico o terapéutico, o ambos, en diferentes ciudades de la costa norte colombiana en el período de 2007 a 2016. Para la tabulación de la información se utilizó el programa Epi Info 7.0. La muestra se integró con 4,245 pacientes. Resultados: El género predominante fue el femenino (53.5%), con una media de edad de 3.9 ± 4.9 años y una mayor prevalencia de 1 a 11 meses de vida (40.6%). Conclusiones: La comunicación interventricular fue la cardiopatía congénita más diagnosticada mediante cateterismo cardíaco (29.2%), seguida por el conducto arterioso persistente (23.1%), comunicación interauricular (11.7%), tetralogía de Fallot (6.8%), estenosis pulmonar (6.7%), transposición de grandes vasos (3.5%), atresia pulmonar con comunicación interventricular (2.5%), canal AV total (2.4%), doble salida ventricular derecha (2.4%), coartación de aorta (1%), insuficiencia mitral (0.98%), atresia tricuspídea (0.96%), atresia pulmonar sin comunicación interventricular (0.73%), doble salida ventricular derecha (0.5%) y otras malformaciones (4.2%).

Abstract Objective: To determine the most frequent congenital heart diseases diagnosed by cardiac catheterization in the pediatric population of the north coast of Colombia, during the period 2007 to 2016. Materials and methods: Descriptive, retrospective and multicentric study; the population corresponds to the total number of patients between 0 and 18 years of age in which diagnostic and therapeutic cardiac catheterization was performed in different cities of the Colombian north coast in the period 2007 to 2016. Epi Info 7.0 software was used for tabulation of information. Total sample was conformed of 4.245 patients. Results: The sex mostly involved was the female with 53.5%, a mean age of 3.9 ± 4.9 years, with a higher prevalence between 1 and 11 months of life with 40.6%. Conclusions: The ventricular septal defect was the most frequent congenital heart disease diagnosed by cardiac catheterization with 29.2%, followed in frequency by the persistent conducto with 23.1%, the atrial septal defect 11.7%, tetralogy of Fallot with 6.8%, pulmonary stenosis with 6.7%, transposition of large vessels 3.5%, pulmonary atresia with ventricular septal defect 2.5%, total AV channel 2.4%, double right ventricular outlet 2.4%, coarctation of aorta on 1 %, mitral insufficiency 0.98%, tricuspid atresia 0.96%, pulmonary atresia without ventricular septal defect 0.73%, double right ventricular outlet 0.5% and other malformations 4.2%.

Echocardiography to estimate high filling pressure in patients with heart failure and reduced ejection fraction.

AIMS: Echocardiographic assessment of left ventricular filling pressures is performed using a multi-parametric algorithm. Unselected sample of patients with heart failure with reduced ejection fraction (HFrEF) patients may demonstrate an indeterminate status of diastolic indices making interpretation challenging. We sought to test improvement in the diagnostic accuracy of standard and strain echocardiography of the left ventricle and left atrium (LA) to estimate a pulmonary capillary wedge pressure (PCWP) > 15 mmHg in patients with HFrEF. METHODS AND RESULTS: Out of 82 consecutive patients, 78 patients were included in the final analysis and right heat catheterization, and echocardiogram was performed simultaneously. According to the univariable analysis, E wave velocity, the ratio between E-wave/A-wave (E/A, area under the curve [AUC] = 0.81, respectively), isovolumic relaxation time (AUC = 0.83), pulmonary vein D wave (AUC = 0.84), pulmonary vein S/D Ratio (AUC = 0.85), early pulmonary regurgitation velocity (AUC = 0.80), and accelerationa time at right ventricular out-flow tract (RVOT AT, AUC = 0.84) identified with the highest accuracy PCWP > 15 mmHg. They were all tested in multivariate analysis, and they were not independently correlated with PCWP. Tricuspid regurgitation (TR) velocity was measurement with the highest predictive value in identifying PCWP > 15 mmHg (AUC = 0.89), compared with other established parameters such as the ratio between e-wave velocity divided by mitral annular e' velocity (E/e'), deceleration time, or LA indexed volume (LAVi), which all reached a lower accuracy level (AUC = 0.75; 0.78; 0.76). Among strain measures, global longitudinal strain in four chamber view (GLS 4ch), the ratio between e-wave velocity divided by mitral annular e' strain rate (E/e'sr), and LA longitudinal strain at the reservoir phase were helpful in estimating elevated PCWP (AUC = 0.77; 0.76; 0.75). According to multivariable analysis, the following two models had the greatest accuracy in detecting PCWP > 15 mmHg: (i) TR velocity, LAVi, and E wave velocity (receiver operating characteristic [ROC]-AUC = 0.98), (ii) AT RVOT, LAVi and GLS 4ch (ROC-AUC = 0.96). Neither E/A (ROC-AUC = 0.81) nor E/e' (ROC-AUC = 0.75) was an independent predictor when included in the model. The two MODELS were applicable to the entire population and demonstrated better agreement with the invasive reference (91% and 88%) than the guidelines algorithm (77%) regardless of the type of rhythm. CONCLUSIONS: Our suggested echocardiographic approach could be used to potentially reduce the frequency of "doubtful" classification and increase the accuracy in predicting elevated left ventricular filling pressure leading to a decrease in the number of invasive assessment made by right heart catheterization.

Risk Factors for Acute Renal Failure after Cardiac Catheterization Most Cited in the Literature: An Integrative Review.

Acute renal failure (ARF) represents 17% of the complications of cardiac catheterization (CC), with a high death rate and longer hospitalization time. The objective of this review is to describe the most cited risk factors for acute kidney failure in the literature. It is a descriptive and exploratory Integrative Literature Review (ILR) with a qualitative approach, using articles published in the Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases between the years of 2009 and 2019 in English, Portuguese, and Spanish, including original articles, reviews, and case studies. The search was made using the following descriptors: cardiac catheterism, kidney diseases, risk factors, coronary catheterization, acute kidney injury, acute renal failure, and nephropathies. The organization and analysis of the data was through the application of a questionnaire that was structured by the authors, and the results are presented in a table. For the final sample, 10 articles were sought. The highlighted factors were being elderly, hypertensive, and diabetic; having previous kidney disease, hypotension, heart failure, higher contrast volumes, and types; the use of non-steroidal anti-inflammatory drugs associated to other risk factors; and atrial fibrillation. Atrial fibrillation was the main finding, which has recently been documented. The identification of risk factors provides health professionals with information to plan measures to prevent ARF, minimizing complications, length of stay, and mortality.

Obstrução do cateter central de inserção periférica nas transfusões de concentrado de hemácias em neonatos / Obstruction of the peripherally inserted central catheter in transfusions of packed red blood cells in neonates

Introdução: O Cateter Central de Inserção Periférica (PICC) é uma tecnologia dura amplamente utilizada em Unidade de Terapia Intensiva Neonatal. Quando o neonato necessita de transfusão de concentrado de hemácias, esse cateter é uma alternativa útil para essa terapêutica. Contudo, torna-se necessário conhecer as causas de uma possível ocorrência de obstrução. Objetivos: avaliar a ocorrência de obstrução do cateter central de inserção periférica após a transfusão de concentrado de hemácias realizada em neonatos e estimar a incidência e o tempo livre de obstrução do cateter nas 24 horas após a transfusão. Método: pesquisa com delineamento do tipo coorte prospectiva, com abordagem quantitativa, desenvolvida na Unidade de Terapia Intensiva Neonatal de um hospital de ensino de Curitiba, Paraná. A amostra foi por conveniência e abrangeu os recém-nascidos que necessitaram de transfusão de concentrado de hemácias durante a utilização do PICC no período de janeiro a julho de 2019. A coleta de dados ocorreu mediante observação direta da transfusão, e da busca e registro de informações contidas nos prontuários dos recém-nascidos até 24 horas após a transfusão. O instrumento de coleta de dados abrangeu variáveis relacionadas aos recém-nascidos, aos PICC e ao desfecho. Resultados: Foram realizadas 46 transfusões de concentrado de hemácias em 24 recém-nascidos por meio de 31 PICC. Predominaram recém-nascidos do sexo masculino (70,8%), prematuros abaixo de 32 semanas (66,7%) e com peso inferior a 1500g (62,5%). Todos os cateteres eram mono lúmens, inseridos em sua maioria (35,4%) nos membros inferiores e 80,6% encontravam-se em posição central no momento da transfusão. Todos os cateteres estavam pérvios no momento da transfusão. Em pouco mais da metade (52,2%) dos PICC estava sendo infundidas três soluções e em 74,2% deles houve apenas uma transfusão de Concentrado de Hemácias. Em 100% dos cateteres foi realizado flushing intermitente. Nesta pesquisa, dentre os 31 acompanhados, um PICC obstruiu 15 minutos após o término da transfusão. A incidência de obstrução foi de 2,2% dos eventos de transfusão, e a probabilidade do PICC livre de obstrução foi de 97,8% 24 horas após a transfusão de concentrado de hemácias. Conclusões: os resultados permitem concluir que a hemotransfusão não foi a variável que contribuiu para a obstrução do PICC, e que este pode ser utilizado com segurança no que diz respeito à obstrução do cateter.

Introduction: The Peripherally Inserted Central Catheter (PICC) is a hard technology widely used in Neonatal Intensive Care Units. When the neonate needs red blood cell transfusion, this catheter is a useful alternative for this therapy. However, it is necessary to know the causes of a possible occurrence of obstruction. Objectives: To evaluate the occurrence of Peripherally Inserted Central Catheter obstruction after transfusion of red blood cells done in newborn babies, and to estimate the incidence and the time free of obstruction of the catheter in the 24 hours after the transfusion. Method: This is a research with prospective cohort outline, with a quantitative approach, developed in a Neonatal Intensive Care Unit of a teaching hospital in Curitiba, Parana. The sample was taken by convenience, and it encompassed newborns babies that needed red blood cells transfusion during the use of the PICC in the period of January-July 2019. Data collection was done through direct observation of the transfusion, and through search and registry of information collected from the patient records of new-borns until 24 hours after transfusion. The data collection instrument encompassed the variables related to the new-borns, that of the PICC, and that of the outcomes. Results: 46 red blood cells transfusion were performed on 24 newborns through 31 PICC. Male sex new-borns (70.8%), premature babies under 32 weeks (66.7%), and with weight under 1500g (62.5%) were predominant. All catheters were mono-lumen, most were inserted in the lower limbs (35.4%), and 80.6% were in central position at the moment of transfusion. All catheters were pervious at the moment of transfusion. In barely more than half (52.2%) of the PICC there were three solutions being infused, and in 74.2% there was only one transfusion done. An intermittent flushing was done in 100% of the PICC. In this research, among the 31 subjects, a single PICC was obstructed 15 minutes after the end of transfusion. The incidence of obstruction was that of 2.2%, and the probability of a PICC free of obstruction was that of 97.8% 24 hours after red blood cells transfusion. Conclusions: The results allow the conclusion that blood transfusion was not the variable that contributed for the obstruction of the PICC, and that may be used safely regarding the obstruction of the catheter.

Transcatheter occlusion of the patent ductus arteriosus in premature infants weighing less than 1200 g.

OBJECTIVES: Over the last few decades different strategies have been proposed to treat persistent ductal patency in premature infants. The advent of the Amplatzer Duct Occluder II Additional Size (ADOIIAS) provided the potential to close the patent ductus arteriosus (PDA). Opinions differ on the significance and treatment of PDA in premature neonates. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterisation can be considered as an alternative means of closing the ductus arteriosus. Our aim was to analyse the feasibility, safety and efficacy of this device in premature infants weighing <1200 g at procedure. METHODS: Eighteen premature infants underwent transcatheter closure. The procedure was performed in the catheterisation laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and ultrasound. We looked at procedural details, device size selection, complications and short-term and mid-term outcomes. RESULTS: Eighteen infants born at gestational ages ranging between 23.6 and 29+6 weeks (mean±SD 25+6±3 weeks) underwent transcatheter PDA closure. Their mean age and weight at the time of the procedure was 20 days (range 8-44 days) and 980 g (range 680-1200 g), respectively. The mean PDA and device waist diameters were 3.2±0.6 mm (range 2.2-4 mm) and 4.5±0.6 mm, respectively, and the mean PDA and device lengths were 4.3±1.2 mm (range 2-10 mm) and 2.5±0.9 mm, respectively. Complete closure was achieved in all but one patient. There was no device migration. One patient developed a left pulmonary artery obstruction. Three infants died. Two deaths were related to complications of prematurity and one to the procedure. CONCLUSIONS: Transcatheter closure of a PDA is feasible in very low weight infants with ADOIIAS and is an alternative to surgery. Success requires perfect selection and placement of the occluder.

Desenvolvimento de protótipo de software para orientação de pacientes sobre cateterismo cardíaco e angioplastia de artéria coronária / Software prototype development to the orientation of patients for cardiac catheterism and coronary artery angioplasty

O objetivo geral desse estudo foi desenvolver um protótipo de um software para sistema web e dispositivo móvel para orientação de pacientes sobre Cateterismo Cardíaco e Angioplastia de Artéria Coronária. Tratou-se de estudo de Design Instrucional do tipo Design Centrado no Usuário, aplicado à produção tecnológica para desenvolvimento do protótipo de um software em ambiente web e tecnologia móvel, para consulta de informações sobre Cateterismo Cardíaco e Angioplastia de Artéria Coronária. O estudo foi desenvolvido em quatro etapas, cada qual permitindo o alcance dos objetivos específicos. Para tanto construiu-se o conteúdo sobre esses exames, tendo como base um levantamento bibliográfico, buscando pelas evidências científicas existentes sobre o tema. A primeira versão do conteúdo foi elaborada e apresentada a experts na área de cardiologia para refinamento. Após essa etapa, foi construída a segunda versão do protótipo do software, submetida à avaliação de 30 pacientes que estavam agendados no setor de hemodinâmica de uma instituição hospitalar pública e de ensino e pesquisa para a realização dos procedimentos de Cateterismo Cardíaco e de Angioplastia de Artéria Coronária. Esta etapa de coleta de dados foi realizada em 2018. Após esta avaliação, elaborou-se a terceira versão do protótipo do software, que posteriormente será encaminhada aos procedimentos de ilustração e informatização, para o sistema web. O estudo deixa sua contribuição para a área de cardiologia, para as ciências de saúde, em especial para a Enfermagem e para o avanço tecnológico nas ciências da saúde, por ter apresentado um conteúdo seguro e baseado em evidências científicas, direcionado aos pacientes submetidos a esses complexos exames. Sua contribuição refere-se, também, ao avanço de conhecimento sobre o tema para essa população de indivíduos. Sua aplicação indica que é um instrumento importante para a educação em saúde desses pacientes, podendo suprir as necessidades do pouco conhecimento sobre o Cateterismo Cardíaco e a Angioplastia da Artéria Coronária demonstrada por eles

The general objective of this study was to develop a software prototype to web system and mobile devices for patients orientation about Cardiac Catheterism and Coronary Artery Angioplasty. It was an Instructional Design, much like User Centered Design, applied to the technological production for the software prototype development on web environment and mobile technology, to search information about Cardiac Catheterism and Coronary Artery Angioplasty. The study was developed in four stages, each one allowing the attainment of specific objectives. In order to do that, the examination content was built based on bibliographic research, searching for existent scientific evidences related to the theme. The first content version was elaborated and presented to experts in the cardiology field to its refinement. Following after this stage, a second version of the software prototype was built, submitted to the evaluation of 30 patients scheduled at the hemodynamic sector of a public hospital institution, academics and research, in order to conduct the proceedings of Cardiac Catheterism and Coronary Artery Angioplasty. This stage of data collection was carried out in 2018. After this evaluation, a third version of the software prototype was elaborated, which subsequently will be referred to the illustration and computerisation proceedings, to the web system. The study leaves its contribution to the cardiology field, health sciences, especially to nursing and technological advancements in health sciences, for having presented a safe content, based on scientific evidences, directioned to the patients submitted to these complex examinations. Its contribution also relates to the knowledge advancements about the theme to this individual population. Its application indicates to be an important instrument for patients health education, being able to supply the needs for having little knowledge about Cardiac Catheterism and Coronary Artery Angioplasty, demonstrated by them

Enterorrhagia due to pelvic hematoma after femoral catheterization / Enterorragia por hematoma pélvico após cateterismo femoral

Arterial puncture, better known as catheterization, has become an important diagnostic tool in recent years. For its realization, generally the option is the Seldinger technique, which is considered today the safest and most often used procedure. This technique allows the insertion of large-caliber or multiple-lumen catheters in the vessel. Arterial catheterization helps in several exams, for instance, mesenteric angiography and cardiac output assessment, and contributes in cineangiocoronariography procedures. We report the case of a 67-year-old male patient who was submitted to cineangiocoronariography and evolved with enterorrhagia due to pelvic hematoma. Throughout the patient's care, a conservative treatment was chosen. The progression of the patient was uneventful and then the patient was discharged. It is very hard to determine which arterial segment was injured; however, as the hematoma was located predominantly in the pelvic region, it is believed that an injury occurred at the internal iliac artery, or directly at the bifurcation of the common iliac artery. Furthermore, it is assumed that a catheter kinking occurred during its progression, due to any tortuosity or to the presence of an atheromatous plaque, thus favoring the occurrence of the more distal lesion, rather than the proximal one. We decided to report this case because of its high degree of rarity, with a scarce number of papers in the literature related to the topic. Thus, with the description of this report we believe that other medical teams will have facilitated their decision-making process, when facing a similar case. (AU)

A punção arterial, mais conhecida como cateterização, tornou-se uma importante ferramenta diagnóstica nos últimos anos. Para sua realização geralmente opta-se pela técnica de Seldinger que é considerada a mais segura e utilizada na atualidade. Esta técnica permite a inserção de cateteres de grosso calibre e ou de múltiplos lúmens em vasos. A cateterização arterial auxilia na realização de exames como arteriografia mesentérica, avaliação do débito cardíaco, além de contribuir na realização da cineangiocoronariografia (CATE). Relata-se um caso de que um paciente masculino de 67 anos que foi submetido ao CATE e evoluiu com enterorragia devido ao hematoma pélvico. Em todo momento foi optado por tratamento conservador. A evolução do paciente ocorreu sem intercorrências e entao o paciente foi de alta. Dificilmente é possível precisar qual segmento arterial foi lesado, entretanto, como o hematoma localizou-se predominantemente na regiao pélvica, acredita-se que ocorreu uma lesão da artéria ilíaca interna ou logo na bifurcação da artéria ilíaca comum. Ademais, supõe-se que aconteceu uma dobra no cateter durante a sua progressão devido a alguma tortuosidade ou mesmo pela presença de placas ateromatosas. Favorecendo, dessa forma, a ocorrência da lesao mais distal e nao proximal. Optou-se por relatar tal caso devido ao alto grau de raridade, e consequentemente, nota-se que há poucos achados na literatura relacionados ao tema. Dessa forma, com a descrição deste relato podem-se ajudar equipes médicas a tomarem condutas quando deparadas com um caso semelhante. (AU)

Infección del tracto urinario por uso del catéter vesical en pacientes ingresados en cuidados intensivos / Infection of the urinary tract due to vesical catheter in patients admitted in intensive care

Se realizó un estudio observacional, descriptivo y transversal de 37 pacientes con infección urinaria luego de la utilización de catéter vesical, ingresados en la sala de Cuidados Intensivos del Hospital Clinicoquirúrgico Docente "Saturnino Lora Torres" de Santiago de Cuba desde mayo de 2011 hasta abril de 2012, con vistas a identificar las causas principales que la ocasionaron. Se halló predominio de los hombres mayores de 60 años que permanecieron expuestos al proceder durante más de 15 días (56,7 %), dado principalmente por la existencia de microorganismos en las floras intestinal y ambiental exógena. Por otra parte, los factores que propiciaron la infección estuvieron asociados a la prolongación del cateterismo vesical, al grupo etario (tercera edad), a la presencia de bacteriuria, al sistema abierto de drenaje y a la administración de antibióticos previa aparición de cepas bacterianas multirresistentes.

An observational, descriptive and cross sectional study of 37 patients with urinary infection after using a vesical catheter, admitted in the Intensive Care Unit of "Saturnino Lora Torres" Teaching Clinical Surgical Hospital from Santiago de Cuba was carried out from May, 2011 to April, 2012, aimed at identifying the main causes producing it. A prevalence of men older than 60 years who remained exposed to this procedure during more than 15 days (56.7%) was found, given mainly by the existence of microorganisms in the exogenous intestinal and environmental floras. On the other hand, the factors causing the infection were associated with the prolonged vesical catheterism, to the age group (third age), to the bacteriuria presence, to the drainage open system and to the administration of antibiotics previous to the emergence of multirresistent bacterial strains.

Cateterismo intervencionista de urgencia en niños menores de un año / Interventional catheterism under emergency conditions for children under one year of age

Objetivo: determinar la efectividad del cateterismo cardíaco intervencionista de urgencia en niños menores de un año, ingresados en el Cardiocentro Pediátrico William Soler, en el período del 1º de enero de 2010 al 31 de diciembre de 2011. Métodos: se realizó un estudio descriptivo y prospectivo. Las variables obtenidas fueron almacenadas y analizadas con el paquete estadístico SPSS versión 15,0. Se emplearon los porcentajes para las variables cualitativas, la media y la desviación estándar para las variables cuantitativas. Se empleó el estadígrafo X² de independencia. Resultados: la muestra quedó conformada por 61 pacientes, 35 de ellos de sexo masculino (57,4 por ciento), y edad menor a un mes en 33. Las cardiopatías congénitas más frecuentes fueron la estenosis pulmonar y la transposición de grandes arterias. La atrioseptostomía de Rashkind (41 por ciento) y la valvuloplastia pulmonar (34,5 por ciento) fueron los procederes más utilizados. Después del cateterismo intervencionista se obtuvo una mejor saturación arterial de oxígeno en el 93,4 por ciento y gradientes pico de presión residual ligero. La bradicardia severa se presentó en 8,1 por ciento de los pacientes complicados. El cateterismo intervencionista de urgencia fue exitoso en 91,8 por ciento de los intervenidos. Conclusiones: el cateterismo intervencionista fue efectivo, permitió mejorar la saturación arterial de oxígeno y lograr gradientes pico de presiones residuales ligeros en la mayoría de los pacientes. La prostaglandina E1 resultó útil para mantener la permeabilidad del conducto arterioso, y permitió la supervivencia de los neonatos al estabilizar el estado clínico antes y después del procedimiento(AU)

Objective: to determine the effectiveness of cardiac interventional catetherism in emergency conditions for children under one-year old admitted to William Soler pediatric cardiocenter from January 1st 2010 to December 31st,2011. Methods: a prospective and descriptive study was conducted. The obtained variables were collected and analyzed with SPSS statistical package 15.0. Percentages, and the median and the standard deviation were used for qualitative variables and quantitative variables, respectively. The independent Chi square statistic was also applied. Results: the final sample was made up of 61 patients, 35 were males (57.4 percent) and 33 aged less than one month. The most common congenital heart diseases were pulmonary stenosis and transposition of the great arteries. Raskind's atrial septostomy (41 percent) and pulmonary valvulopathy (34.5 percent) were the most resorted procedures. After performing interventional catheterism, better artery oxygen saturation was attained in 93.4 percent of cases as well as peak gradients of mild residual pressure. Severe bradychardia occurred in 8.1 percent of patients with complications. Interventional catheterism in emergency conditions succeeded in 91.8 percent of the treated patients. Conclusions: the above-mentioned procedure was effective, allowed improving the artery oxygen saturation and peak gradients of mild residual pressures in most of patients. Prostaglandin E1 proved to be useful in keeping permeability of the arterial duct and made survival of neonates possible since their clinical condition was stabilized before and after the procedure(AU)

Cateterismo intervencionista de urgencia en niños menores de un año / Interventional catheterism under emergency conditions for children under one year of age

OBJETIVO: determinar la efectividad del cateterismo cardíaco intervencionista de urgencia en niños menores de un año, ingresados en el Cardiocentro Pediátrico "William Soler", en el período del 1º de enero de 2010 al 31 de diciembre de 2011. MÉTODOS: se realizó un estudio descriptivo y prospectivo. Las variables obtenidas fueron almacenadas y analizadas con el paquete estadístico SPSS versión 15,0. Se emplearon los porcentajes para las variables cualitativas, la media y la desviación estándar para las variables cuantitativas. Se empleó el estadígrafo X² de independencia. RESULTADOS: la muestra quedó conformada por 61 pacientes, 35 de ellos de sexo masculino (57,4 %), y edad menor a un mes en 33. Las cardiopatías congénitas más frecuentes fueron la estenosis pulmonar y la transposición de grandes arterias. La atrioseptostomía de Rashkind (41 %) y la valvuloplastia pulmonar (34,5 %) fueron los procederes más utilizados. Después del cateterismo intervencionista se obtuvo una mejor saturación arterial de oxígeno en el 93,4 % y gradientes pico de presión residual ligero. La bradicardia severa se presentó en 8,1 % de los pacientes complicados. El cateterismo intervencionista de urgencia fue exitoso en 91,8 % de los intervenidos. CONCLUSIONES: el cateterismo intervencionista fue efectivo, permitió mejorar la saturación arterial de oxígeno y lograr gradientes pico de presiones residuales ligeros en la mayoría de los pacientes. La prostaglandina E1 resultó útil para mantener la permeabilidad del conducto arterioso, y permitió la supervivencia de los neonatos al estabilizar el estado clínico antes y después del procedimiento.

OBJECTIVE: to determine the effectiveness of cardiac interventional catetherism in emergency conditions for children under one-year old admitted to "William Soler" pediatric cardiocenter from January 1st 2010 to December 31st,2011. METHODS: a prospective and descriptive study was conducted. The obtained variables were collected and analyzed with SPSS statistical package 15.0. Percentages, and the median and the standard deviation were used for qualitative variables and quantitative variables, respectively. The independent Chi square statistic was also applied. RESULTS: the final sample was made up of 61 patients, 35 were males (57.4 %) and 33 aged less than one month. The most common congenital heart diseases were pulmonary stenosis and transposition of the great arteries. Raskind's atrial septostomy (41 %) and pulmonary valvulopathy (34.5 %) were the most resorted procedures. After performing interventional catheterism, better artery oxygen saturation was attained in 93.4 % of cases as well as peak gradients of mild residual pressure. Severe bradychardia occurred in 8.1 % of patients with complications. Interventional catheterism in emergency conditions succeeded in 91.8 % of the treated patients. CONCLUSIONS: the above-mentioned procedure was effective, allowed improving the artery oxygen saturation and peak gradients of mild residual pressures in most of patients. Prostaglandin E1 proved to be useful in keeping permeability of the arterial duct and made survival of neonates possible since their clinical condition was stabilized before and after the procedure.

Resistência à flexocompressão de instrumentos endodônticos indicados para canais atresiados e sua correlação com as características morfométricas / Buckling resistance of pathfinders and its geometry

O objetivo deste estudo foi avaliar a resistência à flexocompressão (flambagem) de instrumentos endodônticos empregados no cateterismo de canais radiculares atresiados e se esta varia conforme o comprimento. Flambagem é a deformação lateral apresentada por um instrumento quando submetido a uma força compressiva na direção de seu longo eixo. Foram utilizados instrumentos endodônticos C+File nº 10, K-File nº 10 (Dentsply-Maillefer, Suíça); CC+ nº 10 e C-Pilot nº 10 (VDW, Alemanha), HI-5 nº 10 (Miltex, EUA), Pathfinder CS K2 e Pathfinder SS (SybronEndo, EUA), sendo dez amostras de cada marca comercial em diferentes comprimentos. As dimensões dos instrumentos, tais como diâmetros, comprimento útil, comprimento da parte de trabalho, conicidades, ângulos de inclinação das hélices, ângulo da ponta, forma de seu vértice e presença de ângulo de transição foram determinadas por meio de um microscópio óptico com dispositivo micrométrico acoplado a um computador (Pantec, Panambra, Brasil). Detalhes da forma das pontas e forma das seções retas transversais foram obtidas por meio de um microscópio eletrônico de varredura (MEV - JEOL, JSM-5800, Tókio, Japão). O ensaio de flambagem foi realizado empregando-se uma máquina de ensaio universal (EMIC, DL 10.000, Paraná) e consistiu na aplicação de uma força crescente na direção axial dos instrumentos avaliados, sendo registrada por um software até o deslocamento de 1 mm. A análise dos resultados pelo ANOVA e Tukey revelou que a força máxima para flambar os instrumentos foi maior para os da marca comercial C+File tendo os instrumentos Pathfinder SS apresentado os resultados menos favoráveis. Provavelmente a geometria, que se mostrou completamente distinta para cada grupo de instrumentos, influenciou no comportamento dos mesmos, embora o comprimento não tenha interferido na resistência à flexocompressão.

The aim of this study was to evaluate the buckling resistance of endodontic intruments during the pathfinding of constricted root canals and its lenght influence. Buckling is the elastic deformation of an instrument due to the compressive strenght in its axial direction. The instruments surveyed and tested were: C+File #10, K-File #10 (Maillefer, Switerzland), CC+#10, C-Pilot #10 (VDW, Germany), HI-5 #10 (Miltex, USA) and Pathfinder CS K2 and SS (SybronEndo, USA). Ten instruments from different brands with different lenghts were measured through a optical microscope (Pantec, Panambra, Brazil) aiming to register the diameters, total and useful lenght, taper, helical angles and tip angle, whereas tip details and cross sections were obtained through an electronic microscope MEV (JEOL, JSM-5800). The buckling test was performed at an universal testing machine (EMIC, DL 10.000, Brazil). The maximum load during the elastic deformation was measured by a software while applying increasingly pressure in the axial direction of each instrument till a 1mm deformation. The ANOVA e Tukey test analized the results and revealed that the C+File presented the highest buckling resistance while Pathfinder SS presented the worst results. Different designs might interfere with the results but, in general, the lenght did not have statistical influence.

Preparación del personal de enfermería en la técnica del Cateterismo epicutáneo en Neonatología / Preparation of the nursing personnel in the epicutaneous catheterism technique in Neonatology

Objetivo: identificar la preparación en el desempeño de la técnica del cateterismo epicutáneo en el perfil del egresado en la especialidad de Neonatología. Métodos: se realizaron encuestas a Licenciadas de Enfermería en diferentes servicios de cuidados especiales neonatales de Ciudad de La Habana. Resultados: se detectó no tener incluida esta técnica en el plan de estudio de la Licenciatura en Enfermería así como en los programas docentes de los cursos postbásicos de Neonatología. Conclusiones: los resultados en general de la evaluación del desempeño de los profesionales de enfermería que laboran en los servicios de neonatología reflejan un insuficiente dominio y preparación, relacionado con la técnica del cateterismo epicutáneo y debe incorporarse este proceder al nuevo modelo pedagógico de Licenciatura en enfermería y cursos postbásicos para así mejorar la atención que se presta en estas unidades de atención neonatal(AU)

Objetive: to identify the preparation in the application of the epicutaneous catheterism technique in the Neonatology graduate profile. METHODS: nursing Baccalaureates were surveyed at different special neonatal care services in Havana City. Results: it was found that this technique was not included either in the curriculum of the Nursing Baccalaureate or in teaching programs of the postbasic neonatology courses. Conclusions: the general results of the evaluation of the performance of the nursing professionals working in the neonatology service showed an insufficient control and preparation in connection with the epicutaneous catheterism technique, and the need to incorporate this procedure to the new pedagogical model of Nursing Baccalaureate and to postbasic courses to improve the attention given at these neonatal care units(AU)

Cateterismo urinário: conhecimento e adesão ao controle de infecção pelos profissionais de enfermagem / Urinary catheterism: knowledge and adhesion to the control of infection by the nursing professionals / Cateterismo urinário: conocimiento y adherencia al control de la infección para los profesionales del oficio de enfermeria

A infecção urinária é freqüente nas internações hospitalares e normalmente estão associadas à instrumentação e manuseio do trato urinário. Objetivamos identificar o conhecimento e a adoção das medidas recomendadas para prevenção e controle de infecção no manuseio e instrumentação do trato urinário associado a cateter vesical pelos profissionais de enfermagem e verificar a existência de rotina escrita e capacitação em serviço. Estudo descritivo, realizado em seis hospitais de ensino do município de Goiânia-GO, no ano de 2003. Os dados foram obtidos mediante entrevistas e 216 horas de observação direta. Participaram 67 profissionais da equipe de enfermagem. Medidas relevantes para o controle de infecção como a higienização das mãos são negligenciadas. Há dicotomia entre o conhecimento e a prática dos auxiliares/técnicos de enfermagem com relação às medidas de prevenção e controle de infecção referente ao manuseio do cateter e sistema de drenagem. A maioria dos enfermeiros conhece e observa as medidas fundamentais para o controle de infecção na execução do cateterismo de demora e de alívio. A capacitação acontece de forma assistemática. A maioria dos serviços possui protocolo com a padronização das técnicas. Há necessidade de um investimento na educação continuada para que medidas eficazes do controle de infecção urinária sejam adotadas.

The urinary infection is frequent in hospital internment and normally is in association with tract urinary?s instrumentation. Our aim is to identify the knowledge and the adoption of the recommended behavior for prevention and control of infection in the handling and instrumentation of the urinary tract associated with the vesical catheter by the nursing professionals and to verify the existence of written routine and qualification in service. A descriptive study was carried through in six educational hospitals in the city of Goiânia-GO - Brazil in 2003. The data were obtained by means of interviews and 216 hours of direct observation, 67 professionals of the nursing team took part in the study. Relevant measures for the infection control, such as the hygienic cleaning of the hands is neglected. There is an uneveness between the knowledge and practice of the assistant/the technician of nursing with regard to the measures of prevention and infection control as for the catheter?s caring in the handling and of the draining system. The majority of the nurses knows and observes the basic procedures for the infection control in the execution of the catheterism of delay and relief. The qualification of the nursing professionals happens in a non-sistematic form. The majority of the services, possess protocol with the standardization of the urinary tract manipulation techniques. The data disclose the need of a bigger investment in the continued education so that simple and efficient measurements of the urinary infection control can be adopted.

identificar al conocimiento y la adopción de las medidas recomendadas para la prevención y control de la infección en el manoseo e instrumentación del tracto urinario, y verificar la existencia de la rutina escrita y la capacitación en servicio. Estudio descriptivo, llevado en seis hospitales de educación de la ciudad de Goiânia-GO- Brazil en 2003. Los datos habían sido conseguidos por medio de entrevistas y de 216 horas del observación directa. 67 profesionales del equipo del oficio de enfermeria habían participado del estudio. Los resultados habían demonstrado que excelentes medida para el control de la infección como la limpieza higiénica de las manos están descuidados. Tiene una dicotomía entre el conocimiento y el práctico de la ayudante técnico del cuidado con respecto a las medidas de prevención y de control de la infección cuánto a los cuidados en el manoseo del catéter y del sistema del drenaje. La mayoría de las enfermeras sabe y observa las medidas básicas para el control de la infección en la ejecución del cateterismo de retrasa y relevación. La capacitación de los profesionales del oficio de enfermeria sucede de forma asistemática. La mayoría de los servicios, tienen protocola con la estandardización de las técnicas de la manoseo del tracto urinario. Los datos divulgan la necesidad de un inversión más grande en la educación continuada para adoptar simples y eficientes medida del control de la infección del urinaria.